TX HHS Form 3660. Request for Adaptive Aids. Medical Supplies. Minor Home Modifications or Dental Services/Sedation

The Texas Health and Human Services (HHS) Form 3660, Request for Adaptive Aids, Medical Supplies, Minor Home Modifications or Dental Services/Sedation, is a crucial document that helps individuals with disabilities access necessary support services. This form is typically completed by the individual themselves, along with their case manager, to request adaptive aids, medical supplies, minor home modifications, or dental services/sedation.

The form requires specific information from the individual, including their name, Medicaid number, address, and a description of the item or service requested. The individual must also provide details about their related condition(s) and functional limitations, as well as explain the benefits of the requested item or service. Additionally, the case manager completes Part B of the form, listing non-CLASS resources and the status of each, along with any necessary follow-up actions.

The Form 3660 is an essential tool for individuals seeking adaptive aids, medical supplies, minor home modifications, or dental services/sedation through the Texas HHS. Key features include:

• Required information from the individual, including name, Medicaid number, and address
• Description of the item or service requested
• Explanation of functional limitations and benefits of the requested item or service
• Case manager's role in listing non-CLASS resources and follow-up actions